Tuesday -- Grand Rapids-based Spectrum Health announces it will enter in formal talks to partner with Traverse City-based Munson Healthcare December -- The area's largest group of heart specialists, West Michigan Heart, P.C., announces it will become part of Spectrum Health's in-house medical group July -- West Michigan's largest group of doctors, Michigan Medical, PC, agrees to merge with Spectrum Health June -- Gerber Memorial Health Services in Fremont and Spectrum Health begin investigating a formal alliance, after more than two decades with an informal affiliation March -- Spectrum Health begins exploring an affiliation with Petoskey-based hospital Northern Michigan Regional Health System April 2008 -- Spectrum looks into partnering with the 70-bed Mecosta County Medical Center.

continues its march toward solidifying a dominant regional presence in West and Northern Michigan with the announcement Tuesday of formal talks to partner with Traverse City-based Munson Healthcare. The move comes as Spectrum continues to eye partnerships with a Petoskey-based hospital,

Spectrum also is pursuing a bid to launch a heart transplant program, developing its own in-house physician group and solidifying a teaching partnership with Michigan State University's College of Human Medicine, which is relocating from East Lansing to Grand Rapids. Industry watchers say all these moves better position Grand Rapids' largest hospital system to recruit from a shrinking pool of doctors, negotiate with insurance providers, borrow money and find a seat at the table as federal and state officials work to overhaul the health care system. "In an era where we have to change how things are done anyway (Spectrum) is getting out ahead of the curve," said Lody Zwarensteyn, president of the

Spectrum Health president and CEO, said it is not hard to connect the dots on the organization's long-term plans. "There's a strategy here of trying to make sure we provide affordable high-quality health care across the broader geography," he said. Zwarensteyn said the Alliance for Health has already recommended that a 24-person committee of West Michigan health leaders meeting next week should vote to support Spectrum's bid to start heart transplants. State officials said Tuesday they will make a decision on or before March 3 on Spectrum's request to begin a heart transplant program, said James McCurtis Jr., Michigan Department of Community Health spokesman. Spectrum Heath runs seven hospitals, has 140 service sites; Priority Health, a 500,000-member health insurance company; and 16,000 employees. Traverse City-based Munson Healthcare employs 7,000 people, owns two hospitals, manages another and partners with four others. On Tuesday, leaders from the two non-profits said they have agreed to spend the next four months fact-finding, sharing financial information, and working out the details of a potential affiliation of the entities. Munson Healthcare President and CEO K. Douglas Deck said the partnership gives the northern Michigan organization better access to capital and future physicians because of Spectrum's teaching partnership with MSU. "It is becoming more difficult to recruit physicians to rural American and rural Michigan," Deck said. "We will have a direct pipeline through this relationship to those (MSU-educated) doctors."